Pregnancy While Living with HIV

If you are living with HIV and are pregnant or planning to become pregnant, you may have a lot of questions. The most important thing to know is that many people with HIV have healthy pregnancies and healthy babies. Following your care team's treatment plan lowers the risk of transmitting HIV to your baby.^1,2

Can HIV be passed to my baby?

HIV is a sexually transmitted infection that can pass from mother to baby. This is called mother-to-child transmission (MTCT). MTCT of HIV can happen during pregnancy, birth, or breastfeeding. However, if you have HIV, there are ways to lower the risk of MTCT and safely carry a child.^1,2

How can I lower my risk of mother-to-child transmission?

You can lower the risk of MTCT of HIV by:³

1. Getting tested for HIV and doing prenatal counseling
2. Using antiretroviral therapy (ART) as prescribed
3. Having a cesarean birth
4. Not breastfeeding

In addition, giving the baby anti-HIV drugs after birth lowers their risk of infection. Taking all of these precautions lowers the risk of MTCT of HIV to 1 percent or less.⁴

Testing and prenatal counseling

Knowing your HIV status before pregnancy lowers the risk of MTCT. And HIV treatments are more effective if they are started before pregnancy. If you are able to plan your pregnancy, your care team can make a treatment plan that lowers your risk of passing HIV to your child during pregnancy, labor, or delivery.^1,3

Using ART

HIV is a virus that gets into your blood and copies itself. The number of copies it makes is called the viral load (VL). Doctors use VL to gauge how bad your infection is. The risk of MTCT increases as your VL increases. So, lowering your VL lowers the risk of passing HIV to your baby.^1,2

One of the best ways to keep yourself and your baby healthy is by treating your HIV with ART. ART is a combination of drugs that lowers your VL. These drugs must be taken consistently. Your doctor will prescribe certain drugs and how much to take.^1,3,5

ART for pregnancy

ART is recommended for everyone with HIV, including pregnant people. ART lowers the risk of MTCT of HIV. It is most effective when taken before you get pregnant.^1,3,4

The risk of MTCT of HIV without medical treatment is about 49 percent. Of babies born in this situation:³

• 8 percent get HIV during pregnancy
• 15 percent get HIV during birth
• Up to 26 percent get HIV from breast milk

With ART and proper care, the risk of transmitting HIV to your baby is only 1 to 2 percent. It is even lower if your VL is less than 1,000 copies per milliliter (copies/mL).^3,6

If pregnant people do not get HIV treatment during pregnancy, they can still take antiviral drugs just before delivery to protect their babies. For those who find out they are HIV positive during labor, starting ART lowers the risk of MTCT to about 10 percent. Newborns can also be given ART for the first few weeks of life to decrease their chance of getting HIV.⁵

How does ART affect the baby?

Some studies show that ART may cause certain side effects in babies. ART may also cause changes in the placenta and raise the risk for preterm labor. Potential side effects linked to ART for babies are:³

• Low birth weight
• Preterm birth
• Stillbirth
• Fetal growth restriction
• Changes to brain development

It is important to note that the studies linking these side effects to ART do have some limitations. This makes it hard to draw clear conclusions about the impact of HIV drugs on the placenta and the baby. More research is needed before we can understand the total impact of these drugs.³

ART has been used for pregnant women since 1994, and experts agree that the benefits of ART during pregnancy far outweigh the potential risks. These drugs do lower the risk of MTCT of HIV. Not treating your HIV while pregnant can cause much more severe problems for you and your baby, including the death of your child.³

Cesarean birth

If your VL is more than 1,000 copies/mL, your doctor may recommend a cesarean birth. This decreases the risk of MTCT of HIV during delivery. If your VL is low or undetectable, a vaginal birth may be possible. This is a decision you and your doctors will make as you approach your due date.⁶

Breastfeeding

Whether or not to breastfeed is a personal choice for every birth parent. But there is a risk of transmitting HIV through breast milk. The longer you breastfeed, the higher your chance of passing HIV to the baby will be. This is because the baby is potentially exposed to HIV during every feeding.³

If you choose to breastfeed, following your HIV treatment plan is important. Using ART and having an undetectable VL lowers the risk of MTCT of HIV to less than 1 percent. If you choose not to breastfeed, you may consider using formula or donor milk from a milk bank.⁷